Heart rate, orthostatic test as markers of pathological aging

Background. No increase or decrease in heart rate (HR) after transition to the upright position during orthostatic test is an important criterion for identifying older adults at risk of falls, but its relationship with other geriatric syndromes is unknown. Objective. To investigate the relationship between no increase or decrease of HR after transition to the upright position during orthostatic test and the prevalence of other geriatric syndromes.
Design and methods. A cross-sectional cohort epidemiological study of EUCALYPTUS. Sample: random sample of community-dwelling older adults aged 65 years and older (n = 396). Methods: orthostatic test, analysis of medication therapy, comorbid chronic diseases, laboratory tests, comprehensive geriatric assessment.
Results. No increase/ decrease in HR in the first minute after transition to the upright position during orthostatic test was associated with increased prevalence of frailty, as well as other geriatric syndromes, of which low level of physical function was the most significant. After adjusting for sex and age, atrial fibrillation, cognitive impairment, malnutrition, autonomy decline, and anemia, study participants with low physical function were 3,6 times more likely to find no increase or decrease in HR in the first minute after transition to the upright position during orthostatic test [odds ratio (95 % confidence interval) 3,620 (1,499 to 8,742)].
Conclusions. The use of the marker “no increase/ decrease of HR in the first minute after transition to the upright position during” orthostatic test in older adults can serve as one of the important components of cardiovascular system reserve assessment and diagnosis of patients with decreased functional status and frailty.

1. Tkacheva ON, Kotovskaya YuV, Runikhina NK, Frolova EV, Naumov AV, Vorobyeva NM et al. Clinical guidelines on frailty. Russ J Geriatric Med. 2020;(1):11–46. doi:10.37586/2686-8636-1-2020-11-46. In Russian.

2. Arantes FS, Rosa Oliveira V, Leão AKM, Afonso JPR, Fonseca AL, Fonseca DRP et al. Heart rate variability: a biomarker of frailty in older adults? Front Med (Lausanne). 2022;9:1008970. doi:10.3389/fmed.2022.1008970

3. Weiss CO, Hoenig HH, Varadhan R, Simonsick EM, Fried LP. Relationships of cardiac, pulmonary, and muscle reserves and frailty to exercise capacity in older women. J Gerontol A Biol Sci Med Sci. 2010;65(3):287–294. doi:10.1093/gerona/glp147

4. Turusheva AV, Kotovskaya YuV, Frolova EV. Association between heart rate response during orthostatic test and falls in polymorbid patients aged 60 years and older. Arterial’naya Gipertenziya = Arterial Hypertension. 2019;25(4):433–441. doi:10.18705/1607-419X‑2019-25-4-433-441. In Russian.

5. Vorobyeva NM, Tkacheva ON, Kotovskaya YuV, Ovcharova LN, Selezneva EV. Russian epidemiological study EVKALIPT: protocol and basic characteristics of participants. Russ J Geriatric Med. 2021;(1):35–43. doi:10.37586/2686-8636-1-2021-35-43. In Russian.

6. Turusheva AV, Frolova EV, Degryse J. Development of reference ranges of handgrip strength among healthy adults 65+ in Northwest Russia: a prospective population-based cohort Crystal study. Russian Family Doctor. 2017;21(4):29–35. doi:10.17816/RFD 2017429-35. In Russian.

7. Turusheva AV, Kotovskaya YuV, Frolova EV, Bogdanova ТA, Kutznetsova OYu. The impact of hypertension on mortality and the risk of developing geriatric syndromes. Arterial’naya Gipertenziya = Arterial Hypertension. 2022;28(4):419–427. doi:10.18705/1607-419X‑2022-28-4-419-427. In Russian.

8. Romero-Ortuno R, Cogan L, O’Shea D, Lawlor BA, Kenny RA. Orthostatic haemodynamics may be impaired in frailty. Age Ageing. 2011;40(5):576–83. doi:10.1093/ageing/afr076

9. Cybulski G, Niewiadomski W. Influence of age on the immediate heart rate response to the active orthostatic test. J Physiol Pharmacol. 2003;54(1):65–80.

10. Parvaneh S, Howe CL, Toosizadeh N, Honarvar B, Slepian MJ, Fain M et al. Regulation of cardiac autonomic nervous system control across frailty statuses: a systematic review. Gerontology. 2015;62(1):3–15. doi:10.1159/000431285

11. Toosizadeh N, Ehsani H, Parthasarathy S, Carpenter B, Ruberto K, Mohler J et al. Frailty and heart response to physical activity. Arch Gerontol Geriatr. 2021;93:104323. doi:10.1016/j.archger.2020.104323

12. Ustin M, Zor’kina A, Choronenko S. Effect of iron deficiency anemia on heart rate variability. Russ J Cardiol. 2020;25:5–16. In Russian.

13. Denisova TP, Cherevatova OM. Anemic syndrome influence on arrhythmia incidence in geriatric patients. Russ J Cardiol. 2006;4:20–23. In Russian.

14. Gehi A, Ix J, Shlipak M, Pipkin SS, Whooley MA. Relation of anemia to low heart rate variability in patients with coronary heart disease (from the Heart and Soul study). Am J Cardiol. 2005;95(12):1474–1477. doi:10.1016/j.amjcard.2005.02.017

15. Lopresti AL. Association between micronutrients and heart rate variability: a review of human studies. Adv Nutr. 2020;11(3):559–575. doi:10.1093/advances/nmz136